Healthcare Provider Details

I. General information

NPI: 1619865763
Provider Name (Legal Business Name): CARYLYN BODAMMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S 84TH ST
OMAHA NE
68124-3215
US

IV. Provider business mailing address

17054 ORCHARD AVE
OMAHA NE
68135-1452
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-7726
  • Fax:
Mailing address:
  • Phone: 402-878-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number63629
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: